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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000176
Report Date: 05/31/2022
Date Signed: 06/01/2022 02:12:58 PM


Document Has Been Signed on 06/01/2022 02:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:AREVALO'S BOARD & CARE HOMEFACILITY NUMBER:
306000176
ADMINISTRATOR:AREVALO, VIOLETA D.FACILITY TYPE:
740
ADDRESS:10462 POONA DR.TELEPHONE:
(714) 774-0455
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:6CENSUS: 0DATE:
05/31/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Violeta Arevalo via telephoneTIME COMPLETED:
01:00 PM
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At approximately 12:30 PM , Licensing Program Analyst (LPA) Lydia Martinez attempted to conduct a visit for the purpose of a Required Random visit. LPA rang the doorbell and knocked on the door several times and received no response. LPA looked through window and noticed home is vacant. LPA noticed a For Sale sign in front of the home. LPA Martinez contacted Licensee/Administrator (L/AD) Violeta Arevalo via telephone. L/AD Arevalo stated she closed the facility at the end of April 2022. Stated she did not know who to send Notice to at Licensing but did notify Regional Center of Orange County. L/AD stated she only had one client who was placed at another Board and Care. LPA requested L/AD Arevalo to please mail her license and notice of closure to CCLD to which Ms. Arevalo agreed to.

LPA to email copy of report to L/AD Arevalo.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia MartinezTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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